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The small height of an anastomotic colonic doughnut is an independent risk factor of anastomotic leakage following colorectal resection: results of a prospective study on 154 consecutive cases

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Abstract

Purpose

The aim of this prospective study was to assess the influence of morphological characteristics of anastomotic doughnuts on the risk of anastomotic leakage (AL) after double-stapled colorectal anastomosis.

Methods

This single-center prospective study enrolled all patients undergoing double-stapled colorectal anastomosis between December 2012 and December 2015. Maximal diameter and minimal and maximal heights and widths of both colonic and rectal doughnuts were measured by surgeons in the operating room. Their influence on the risk of AL was analyzed on uni- and multivariate models.

Results

One hundred fifty-four patients were included; 92 (59.7%) were operated on for malignancy. Colorectal anastomoses > and <10 cm above the anal verge were performed in 96 (62.3%) and 58 (37.7%) patients, respectively. AL occurred in 17 (11.0%). The minimal height of the colonic doughnut (CD) was the only measurement significantly associated with an increased risk of AL (p = 0.026). A cutoff value of 4.5 mm for the CD determined on the ROC curve (AUC 0.685, p = 0.013) yielded the best sensitivity (61.4%) and specificity (82.4%) to predict AL. On multivariate analysis, a height of the CD <4.5 mm (OR 5.743, 95% IC 1.476–22.346, p = 0.012), malignant disease (OR 8.821, 95% IC 1.051–74.006, p = 0.045), and American Society of Anesthesiologists score >2 (OR 3.408, 95% IC 1.017–11.418, p = 0.047) were the only independent risk factors of AL.

Conclusion

The CD’s minimal height influences the risk of AL. Its routine measurement during operation, along with other risk factors, could help to decide which patients could benefit from a diverting stoma or the creation of a new anastomosis.

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Authors’ contributions

Study concept and design: Angliviel, Benoist, Cauchy, and Brouquet

Acquisition of data: Brouquet, Abdalla, Lambert, Costaglioli, Angliviel, Benoist, Penna, and Cauchy

Analysis and interpretation of data: Cauchy, Abdalla, Brouquet, and Benoist

Drafting of the manuscript: Cauchy, Abdalla, Brouquet, and Benoist

Critical revision of the manuscript: Benoist, Brouquet, and Penna

Statistical analysis: Cauchy and Brouquet

Study supervision: Benoist and Brouquet

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Hôpital Bicêtre, University Paris Sud XI, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France

    François Cauchy, Solafah Abdalla, Christophe Penna, Benjamin Angliviel, Benoit Lambert, Bruno Costaglioli, Antoine Brouquet & Stéphane Benoist

Authors
  1. François Cauchy
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  2. Solafah Abdalla
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  3. Christophe Penna
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  4. Benjamin Angliviel
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  5. Benoit Lambert
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  6. Bruno Costaglioli
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  7. Antoine Brouquet
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  8. Stéphane Benoist
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Corresponding author

Correspondence to Antoine Brouquet.

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Cauchy, F., Abdalla, S., Penna, C. et al. The small height of an anastomotic colonic doughnut is an independent risk factor of anastomotic leakage following colorectal resection: results of a prospective study on 154 consecutive cases. Int J Colorectal Dis 32, 699–707 (2017). https://doi.org/10.1007/s00384-017-2769-9

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  • DOI: https://doi.org/10.1007/s00384-017-2769-9

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